Hip Fracture

Fractures of the hip often occur just below the ball of the hip (femur). They usually result from a fall or direct hit (trauma). If the hip fracture passes through the entire bone (complete), the two bone fragments have the potential to shift out of proper alignment (displaced). Hip fractures may occur in athletes of all ages. However, they are rare in younger people and tend to occur in older athletes.

SYMPTOMS

Severe pain in the hip or groin.

Pain that gets worse with movement of the hip or when trying to bear weight on the affected leg.

Tenderness, bleeding, bruising, or swelling of the hip.

Visible deformity, such as the leg appearing shortened or the foot turned out.

Inability to stand.

Loss of pulse, numbness, tingling, or paralysis below the fracture site (rare).

CAUSES

A fracture results when the force applied to a bone is greater that the strength of the bone. Hip fractures are usually the result of direct trauma, such as a fall.

Indirect stress, caused by twisting or violent muscle contraction.

RISK INCREASES WITH:

Age (greater than 60 years).

Contact sports and falls from heights.

Cycling.

Poor balance.

Bone defects or diseases (i.e. osteoporosis, tumors of the bone or bone marrow).

Poor nutrition, especially calcium or protein deficiency.

Poor hip strength and flexibility.

PREVENTION

Maintain physical fitness:

Hip strength.

Flexibility and endurance.

Cardiovascular fitness and good balance skills.

Wear properly fitted and padded protective equipment (hip pads).

Learn and use proper exercise technique.

Maintain appropriate nutrition and calcium intake.

PROGNOSIS

If treated properly, hip fractures usually heal within 6 to 12 weeks. Healing is not considered complete until there is no pain or motion at the fracture site, and x-rays (radiographs) show complete bone healing (union).

RELATED COMPLICATIONS

Low blood volume (hypovolemic) shock, due to blood loss within the thigh.

Bone fails to heal (nonunion).

Bone heals in a poor position (malunion).

Interruption of blood supply that leads to death of bone tissue.

Shortening or deformity of the fractured bone.

Stopping (arrest) of bone growth in young people.

Arthritic hip joint.

Risks of surgery: infection, bleeding, injury to nerves, excessive loss of blood, need for blood transfusion, injury to joint cartilage, pain from hardware (plates or screws), development of clots in the calf or thigh veins, which may break off and go to the lungs (pulmonary embolus), arthritis, hip dislocation, more surgery.

TREATMENT

If the fracture is displaced, it must be put back in alignment (reduced) immediately, which requires surgery. For severe fractures, the hip may not be able to be realigned, and it is necessary to replace the bones with either a partial or total hip replacement. Surgery will allow the patient to become mobile in less time, due to screws and pins that are stabilizing the fracture. If the fracture is non-displaced, and surgery is not required, bed rest with traction or a body cast for 6 to 8 weeks can be expected. After initial treatment, ice and medicines will help reduce pain and inflammation. To limit pressure on the fracture, crutches are often given, with instructions to either be partial or non-weight bearing on the affected leg. It is important to know that restraining any part of the body for a long period of time can cause muscle loss, joint stiffness, orfluid build up in the tissues (edema). After a period of restraint, physical therapy may be required to regain strength and range of motion.

MEDICATION

If surgery is involved, general anesthesia, sedation, or muscle relaxants may be necessary.

If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

Do not take pain medicine for 7 days before surgery.

Prescription pain relievers may be given. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

The following occur after surgery. (Report any of these signs immediately):

Signs of infection, including fever, increased drainage of fluids, or redness from the hip wound.

Swelling above or below the fracture site.

Severe, persistent pain.

Blue or gray skin below the fracture site, especially under the toenails. Numbness or loss of feeling below the fracture site.